ATI ENGAGE EXAM 2 MASTER TEST BANK
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All Questions and Correct Answers | Verified |
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Brand New 2026/2027 Version --- --- ---
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SECTION 1: VITAL SIGNS ASSESSMENT (Questions 1–40)
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Question 1: A nurse is reviewing documentation of vital signs by
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a newly licensed nurse. Which of the following pieces of
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documentation is correct? --- --- ---
• A) Pulse 52/min
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• B) Respiratory rate 24
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• C) SaO2 97% right index finger, room air
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• D) Blood pressure 132/86 mm Hg
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Answer: C --- ---
Rationale: The correct documentation is "SaO2 97% right index
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finger, room air" because it is thorough and complete, including
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the measurement, the site used, and that the client is not on
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oxygen. Documentation of pulse should include the site (e.g.,
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,radial, apical). Respiratory rate documentation should include
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the character (e.g., regular, labored) .
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Question 2: A nurse is planning care for a group of clients and is
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-- delegating to assistive personnel (AP) to take the clients' vital
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signs. For which of the following clients should the nurse obtain
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the vital signs rather than the AP?
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• A) A client who just received the fourth dose of an antibiotic
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for an infection --- --- ---
• B) A client who has heart failure and is scheduled for
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discharge later in the day --- --- --- --- ---
• C) A client who is 24 hr postoperative and is visiting with
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friends ---
• D) A client who was recently admitted and reports chest
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pain ---
Answer: D --- ---
Rationale: The nurse should identify that a new onset of chest
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pain is an acute change in condition. The nurse should not
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delegate this task to the AP. Once the client is stable, the nurse
--- --- --- --- --- --- --- --- --- --- --- --- ---
can delegate subsequent measurement of vital signs to an AP .
--- --- --- --- --- --- --- --- --- --- ---
, ---
Question 3: A nurse is caring for a client who has an increase in
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cardiac output. Which of the following findings should the nurse
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expect? ---
• A) Increase in blood pressure
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• B) Decrease in respiratory rate
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• C) Decrease in heart rate
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• D) Increase in stroke volume
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Answer: A --- ---
Rationale: An increase in cardiac output causes an increase in
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the client's blood pressure. Cardiac output is the amount of blood
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- pumped by the ventricles in 1 minute. Cardiac output is
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calculated as heart rate × stroke volume . --- --- --- --- --- --- --- ---
---
Question 4: A nurse is contributing to the plan of care for a
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client who has hypertension. Which of the following interventions
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should the nurse recommend? (Select all that apply.)
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• A) Provide the client with low-sodium meals and snacks
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, • B) Encourage the client to participate in physical activity
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each day --- ---
• C) Instruct the client in the use of relaxation techniques
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• D) Inform the client of the importance of abstaining from
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products containing nicotine --- --- ---
• E) Encourage the client to increase fluid intake to 2 L per
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day ---
Answer: A, B, C, D --- --- --- --- ---
Rationale: A diet high in sodium can cause an increase in blood
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pressure. Daily physical exercise can decrease blood pressure.
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Relaxation techniques decrease stress, lower heart rate, and
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decrease blood pressure. Nicotine is a stimulant that increases
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heart rate and blood pressure and causes vasoconstriction .
--- --- --- --- --- --- --- --- ---
---
Question 5: A nurse is planning care for a group of clients and is
--- --- --- --- --- --- --- --- --- --- --- --- --- -
-- reviewing recent vital signs obtained by an AP. From which of
--- --- --- --- --- --- --- --- --- --- ---
the following clients should the nurse collect further data?
--- --- --- --- --- --- --- --- ---
• A) A 17-year-old who has a respiratory rate of 16/min
--- --- --- --- --- --- --- --- --- ---
• B) A young adult who has a pulse rate of 98/min
--- --- --- --- --- --- --- --- --- --- ---
--- --- --- --- --- --- ---
All Questions and Correct Answers | Verified |
--- --- --- --- --- --- --- ---
Brand New 2026/2027 Version --- --- ---
---
SECTION 1: VITAL SIGNS ASSESSMENT (Questions 1–40)
--- --- --- --- --- --- ---
Question 1: A nurse is reviewing documentation of vital signs by
--- --- --- --- --- --- --- --- --- --- ---
a newly licensed nurse. Which of the following pieces of
--- --- --- --- --- --- --- --- --- ---
documentation is correct? --- --- ---
• A) Pulse 52/min
--- --- ---
• B) Respiratory rate 24
--- --- --- ---
• C) SaO2 97% right index finger, room air
--- --- --- --- --- --- --- ---
• D) Blood pressure 132/86 mm Hg
--- --- --- --- --- ---
Answer: C --- ---
Rationale: The correct documentation is "SaO2 97% right index
--- --- --- --- --- --- --- --- ---
finger, room air" because it is thorough and complete, including
--- --- --- --- --- --- --- --- --- ---
the measurement, the site used, and that the client is not on
--- --- --- --- --- --- --- --- --- --- --- ---
oxygen. Documentation of pulse should include the site (e.g.,
--- --- --- --- --- --- --- --- ---
,radial, apical). Respiratory rate documentation should include
--- --- --- --- --- --- ---
the character (e.g., regular, labored) .
--- --- --- --- --- ---
---
Question 2: A nurse is planning care for a group of clients and is
--- --- --- --- --- --- --- --- --- --- --- --- --- -
-- delegating to assistive personnel (AP) to take the clients' vital
--- --- --- --- --- --- --- --- --- ---
signs. For which of the following clients should the nurse obtain
--- --- --- --- --- --- --- --- --- --- ---
the vital signs rather than the AP?
--- --- --- --- --- --- ---
• A) A client who just received the fourth dose of an antibiotic
--- --- --- --- --- --- --- --- --- --- --- ---
for an infection --- --- ---
• B) A client who has heart failure and is scheduled for
--- --- --- --- --- --- --- --- --- --- ---
discharge later in the day --- --- --- --- ---
• C) A client who is 24 hr postoperative and is visiting with
--- --- --- --- --- --- --- --- --- --- --- ---
friends ---
• D) A client who was recently admitted and reports chest
--- --- --- --- --- --- --- --- --- ---
pain ---
Answer: D --- ---
Rationale: The nurse should identify that a new onset of chest
--- --- --- --- --- --- --- --- --- --- ---
pain is an acute change in condition. The nurse should not
--- --- --- --- --- --- --- --- --- --- ---
delegate this task to the AP. Once the client is stable, the nurse
--- --- --- --- --- --- --- --- --- --- --- --- ---
can delegate subsequent measurement of vital signs to an AP .
--- --- --- --- --- --- --- --- --- --- ---
, ---
Question 3: A nurse is caring for a client who has an increase in
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
cardiac output. Which of the following findings should the nurse
--- --- --- --- --- --- --- --- --- ---
expect? ---
• A) Increase in blood pressure
--- --- --- --- ---
• B) Decrease in respiratory rate
--- --- --- --- ---
• C) Decrease in heart rate
--- --- --- --- ---
• D) Increase in stroke volume
--- --- --- --- ---
Answer: A --- ---
Rationale: An increase in cardiac output causes an increase in
--- --- --- --- --- --- --- --- --- ---
the client's blood pressure. Cardiac output is the amount of blood
--- --- --- --- --- --- --- --- --- --- --
- pumped by the ventricles in 1 minute. Cardiac output is
--- --- --- --- --- --- --- --- --- ---
calculated as heart rate × stroke volume . --- --- --- --- --- --- --- ---
---
Question 4: A nurse is contributing to the plan of care for a
--- --- --- --- --- --- --- --- --- --- --- --- ---
client who has hypertension. Which of the following interventions
--- --- --- --- --- --- --- --- ---
should the nurse recommend? (Select all that apply.)
--- --- --- --- --- --- --- ---
• A) Provide the client with low-sodium meals and snacks
--- --- --- --- --- --- --- --- ---
, • B) Encourage the client to participate in physical activity
--- --- --- --- --- --- --- --- ---
each day --- ---
• C) Instruct the client in the use of relaxation techniques
--- --- --- --- --- --- --- --- --- ---
• D) Inform the client of the importance of abstaining from
--- --- --- --- --- --- --- --- --- ---
products containing nicotine --- --- ---
• E) Encourage the client to increase fluid intake to 2 L per
--- --- --- --- --- --- --- --- --- --- --- ---
day ---
Answer: A, B, C, D --- --- --- --- ---
Rationale: A diet high in sodium can cause an increase in blood
--- --- --- --- --- --- --- --- --- --- --- ---
pressure. Daily physical exercise can decrease blood pressure.
--- --- --- --- --- --- --- ---
Relaxation techniques decrease stress, lower heart rate, and
--- --- --- --- --- --- --- ---
decrease blood pressure. Nicotine is a stimulant that increases
--- --- --- --- --- --- --- --- ---
heart rate and blood pressure and causes vasoconstriction .
--- --- --- --- --- --- --- --- ---
---
Question 5: A nurse is planning care for a group of clients and is
--- --- --- --- --- --- --- --- --- --- --- --- --- -
-- reviewing recent vital signs obtained by an AP. From which of
--- --- --- --- --- --- --- --- --- --- ---
the following clients should the nurse collect further data?
--- --- --- --- --- --- --- --- ---
• A) A 17-year-old who has a respiratory rate of 16/min
--- --- --- --- --- --- --- --- --- ---
• B) A young adult who has a pulse rate of 98/min
--- --- --- --- --- --- --- --- --- --- ---
